Is impaired sleep quality responsible for a nondipping pattern even in normotensive individuals?

Ulu, Sena; Ulu, Şahin; Ulaşlı, Sevinç Sarınç; Yaman, Gökhan; Ahsen, Ahmet; Özkeçeci, Gülay; Yüksel, Şeref

doi:10.1097/mbp.0b013e3283624b03

Cited by 13 publications

(10 citation statements)

References 28 publications

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“…To explain our results, we can hypothesize that while insomnia led to HT through the hyperarousal level, a stressor state inducing activation of the sympathetic system and proinflammatory processes and endothelial dysfunction, 16 in the elderly without insomnia, age-related physiological changes in sympathetic activity and nocturnal BP control 37 may prevent HT occurrence. Examining baroreceptor sensitivity (an indirect marker of sympathetic activity) 26 and nocturnal BP dipping (an initial marker of HT), 38 we observed no significant differences in the baroreceptor sensitivity or in the decline in nocturnal BP between poor and good sleepers or between short and long sleepers. Thus, healthy elderly subjects without insomnia do not have the hyperarousal state proposed to explain the increased HT risk in insomnia patients.…”

Section: Discussionmentioning

confidence: 77%

Association of Self-Reported Sleep and Hypertension in Non-Insomniac Elderly Subjects

Sforza

Martin

Barthélemy

et al. 2014

Journal of Clinical Sleep Medicine

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Objectives: Sleep duration and sleep quality play important roles in the development of hypertension (HT) in middle-aged subjects, with controversial data in elderly. In this study, we investigated the link between HT and self-reported sleep in non-insomniac elderly subjects. Methods: We examined 500 participants without insomnia complaints aged 72 ± 1 years. An extensive instrumental evaluation was carried out, including 24-h blood pressure (BP) monitoring and an assessment of nocturnal BP dipping. Sleep duration and quality were evaluated by the Pittsburgh Sleep Quality Index (PSQI). The subjects were stratifi ed into three groups according to sleep duration: short (< 6 h), normal (> 6h to < 8 h), and long (> 8 h) sleepers. A PSQI < 5 defi ned good sleepers (GS, n = 252), and a PSQI > 5 (n = 248) defi ned poor sleepers (PS). Results: PS represented 50% of the subjects, more frequently females. Compared to GS, PS did not differ in terms of HT, BP, barorefl ex sensitivity (BRS), and BP dipping. Short, normal, and long sleepers accounted for 28%, 42%, and 30% of subjects, with HT, BP values, BRS, and gender not differing between groups. No relationship was found between nocturnal BP values and self-reported sleep measures. Logistic regression analysis indicated that neither sleep duration nor sleep quality predicts the prevalence of HT, the body mass index being the only factor affecting this association. Clinical Trial Registration: ClinicalTrials.gov identifi ers NCT00759304 and NCT00766584 Conclusions: In a sample of non-insomniac elderly subjects, neither sleep duration nor sleep quality affected the prevalence of HT. These data argue against a relationship between selfreported sleep duration and quality and HT in elderly without insomnia. Keywords: hypertension, blood pressure, elderly, sleep duration, sleep quality, Pittsburgh Sleep Quality Index questionnaire Citation: Sforza E, Saint Martin M, Barthelemy JC, Roche F. Association of self-reported sleep and hypertension in non-insomniac elderly subjects. J Clin Sleep Med 2014;10(9):965-971.

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Section: Discussionmentioning

confidence: 77%

Association of Self-Reported Sleep and Hypertension in Non-Insomniac Elderly Subjects

Sforza

Martin

Barthélemy

et al. 2014

Journal of Clinical Sleep Medicine

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“…In a normotensive person the BP circadian rhythm is characterized by a steep nocturnal/sleep decrease called BP dipping and a rise in the wake-associated elevations of BP. Non-dipping in BP is associated with CVD risk [63] and has been associated with poor sleep [64]. Increased BP during sleep deprivation could be due to a combination of factors such as increased sympathetic outflow to the heart or periphery, decreased baroreflex sensitivity and a resetting of the baroreflex set-point to a higher level.…”

Section: Sleep Loss and Its Role In The Development Of Cardiometabmentioning

confidence: 99%

Association between sleep deficiency and cardiometabolic disease: implications for health disparities

Rangaraj

Knutson

2016

Sleep Medicine

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Cardiometabolic diseases, which include obesity, diabetes, hypertension and cardiovascular disease, are associated with reduced quality of life and reduced life expectancy. Unfortunately, racial/ethnic and socioeconomic disparities in these diseases exist such that minority populations, such as African Americans and Hispanics, and those of lower socioeconomic status, experience a greater burden. Several reports have indicated that there are differences in sleep duration and quality that mirror the disparities in cardiometabolic disease. The goal of this paper is to review the association between sleep and cardiometabolic disease risk because of the possibility that suboptimal sleep may partially mediate the cardiometabolic disease disparities. We will review both experimental studies that have restricted sleep duration or impaired sleep quality and examined biomarkers of cardiometabolic disease risk, including glucose metabolism and insulin sensitivity, appetite regulation and food intake, and immune function. We will also review observational studies that have examined the association between habitual sleep duration and quality and the prevalence or risk of obesity, diabetes, hypertension and cardiovascular disease. Many experimental and observational studies do support an association between suboptimal sleep and increased cardiometabolic disease risk.

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“…Poor sleep quality may be associated with nondipping patterns through their disruption of the circadian rhythm . This association is supported by previous research reporting higher PSQI global scores for nondippers than dippers . However, no meta‐analysis has been conducted to summarize these findings.…”

Section: Introductionmentioning

confidence: 99%

Subjective sleep quality, blood pressure, and hypertension: a meta‐analysis

Woo

Wong

et al. 2018

J of Clinical Hypertension

141

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Sleep quality is an important aspect of sleep, but no meta-analysis has elucidated its relationship with blood pressure (BP) and hypertension. A meta-analysis was conducted in October 2016 using multiple databases, including Embase and Medline.Studies that assessed subjective sleep quality and BP or hypertension were included.Upon full-text evaluation, 29 articles from 45 041 patients were selected, of which 22 articles were included in the meta-analysis and seven were presented narratively. Poor sleep quality was significantly associated with a greater likelihood of hypertension (odds ratio, 1.48; P value = .01). Poor sleepers had higher average systolic BP (mean difference = 4.37, P value = .09) and diastolic BP (mean difference = 1.25, P value = .32) than normal sleepers without statistical significance. Patients with hypertension had significantly worse sleep quality scores (mean difference = 1.51, P value < .01), while BP dippers had significantly better scores (mean difference = −1.67, P value < .01).The findings highlight the relationship between sleep quality and hypertension. global PSQI scores (indicative of poorer sleep quality) than patients with normotension. 14,20 Apart from its association with BP, poor sleep quality may be associated with the dipping pattern of BP. For a healthy patient, there is at least a 10% reduction in nocturnal BP as compared with daytime BP; such a patient is characterized as a "dipper."21 "Nondippers" demonstrate an increased activity in the sympathetic nervous system and a decreased activity in the parasympathetic nervous system, which probably explains the higher nocturnal BP. 22 Nondipping BP is associated with higher risk for cardiorenal organ damage such as left ventricular hypertrophy and cerebrovascular diseases. 23 Poor sleep quality may be associated with nondipping patterns through their disruption of the circadian rhythm. 24This association is supported by previous research reporting higher PSQI global scores for nondippers than dippers. 25,26 However, no metaanalysis has been conducted to summarize these findings.Current evidence suggests a potential association between poor subjective sleep quality and hypertension, but it has not been verified through a systematic approach. The primary aims of the present systematic review and meta-analysis are to summarize current evidence and to determine whether poor subjective sleep quality is associated with elevated BP. The secondary aim is to examine whether the associations differ by geographic regions. | METHODS | Search strategyMultiple databases were used for the present review, namely Medline Search terms included a combination of synonyms of "sleep quality," 9 "hypertension," 3 and "blood pressure" 3 as adapted from relevant review articles. 3,9 All articles with English abstracts were assessed. | Study inclusion criteria• Primary studies with a cross-sectional, prospective, or retrospective design• Studies that examined sleep quality with a self-reported questionnaire• Studies that defined hypertension with cri...

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Is impaired sleep quality responsible for a nondipping pattern even in normotensive individuals?

Cited by 13 publications

References 28 publications

Association of Self-Reported Sleep and Hypertension in Non-Insomniac Elderly Subjects

Association of Self-Reported Sleep and Hypertension in Non-Insomniac Elderly Subjects

Association between sleep deficiency and cardiometabolic disease: implications for health disparities

Subjective sleep quality, blood pressure, and hypertension: a meta‐analysis

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